ANNEX “A”

Quezon City

CHECKLIST OF REQUIREMENTS
(FOR TAX EXEMPTION APPLICATION OF SEPARATION BENEFITS
UNDER SECTION 32 (B)(6)(b) OF THE NIRC, AS AMENDED
DUE TO DEATH, SICKNESS/PHYSICAL DISABILITY)

 Submitted X Not Submitted N/A

Not Applicable

Document Remarks
1. Application letter stating the factual and legal basis for tax
exemption
2. Certified true copy of Death Certificate, if separation was
due to death of employee
3. If separation was due to sickness/physical disability:
a) Sworn Affidavits to be executed by the
employer’s physician and the Head of
Office/Entity, attesting to the fact that the
retiring/separated official or employee is
suffering from a serious illness or physical
disability that affects the performance of his
duties and endangers his life, if he continues
working
b) Clinical Record of the official/employee
concerned indicating the history of
illness/physical disability and initial diagnosis
c) Laboratory examination confirming the illness
suffered by such official/employee or medical
certificate confirming the physical disability of
the official/employee
Other documents submitted:

Instruction: Please complete and submit the foregoing documentary requirements to the
Revenue District Office (RDO) having jurisdiction over the principal place of business of
the employer for processing of the tax exemption confirmation.